Temporal trend and factors associated with cesarean section in Ribeirão Preto, Brazil, birth cohorts

The aim of this study was to assess the trend in cesarean section rates in three birth cohorts conducted in Ribeirão Preto, São Paulo, Brazil, in different years (1978/79, 1994, and 2010), and to investigate the sociodemographic and economic factors associated with cesarean delivery in these cohorts. Data were obtained from the database of the cohorts. Women were interviewed shortly after delivery and information was collected from their medical records. The chi-square test was used to compare the proportion of covariates between modes of delivery. Unadjusted and adjusted Poisson regression models were applied to evaluate the association between cesarean section and the covariates studied in the three cohorts, with the significance level set at α < 0.05. There was a marked upward trend in cesarean delivery across the cohorts. The increase was more pronounced among women with higher educational levels, older age, and better socioeconomic conditions. In adjusted analyses, sociodemographic and economic variables remained significantly associated with a higher likelihood of cesarean delivery in all cohorts.